Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 51474 | SC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | Q6275 | TX |
NPI | 1578855433 |
---|---|
Provider Name | Dr. Joseph L. A. Russell |
First Address | North Charleston, SC 29420-4211 |
Second Address | North Charleston, SC 29420-4211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 17/03/2018 |